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A quick reminder about the Child Survival Sustainability Assessment Framework

Conceptually, sustainability in Child Survival and Health projects is thought of as a contribution to the development of conditions enabling individuals, communities, and local organizations to reach their potential. This includes improving local functionality, developing mutual relationships of support and accountability, and decreasing dependency on insecure resources (financial, human, technical, informational), in order for local stakeholders to negotiate their respective roles in the pursuit of health, wellness and development, beyond a project intervention.

The individuals, communities and local organizations constitute a local system with their environment. It is ultimately their coordinated social interactions and efforts, based on the understanding of their own health and development, that will lead to lasting health impact.

The logic of this definition implies the loss of control over local processes inherent to project approaches. This places the immediate determinant of sustainability--local process of negotiation, role definition, and engagement--outside of the full control of a PVO. The responsibility of a PVO is not lessened by this recognized loss of control. CS projects are in a critical position to advance key conditions in the local system where they intervene, if not directly, then by helping the local communities and stakeholders address these conditions.

While every element is defined contextually, the CSSA offers three dimensions, and six components which are considered relevant to the diversity of primary health intervention strategies of the PVO community:

1. The first dimension consists of elements reflecting the health and health services situation of the local system:
   • The first component is the population’s health status (or proxies, such as immunization coverage).
   • The second component consists of elements in the health and social services approach and quality, which will influence the durability of any health improvement, such as access (including cost), effectiveness, equity, appropriateness and fit of the activities.
2. The second dimension consists of elements reflecting local organizational capacity and viability:
   • The first component of this second dimension represents the organizational capacity, which needs to exist in the local partner(s) to maintain performance.
   • The second component represents the organizational viability of this key local partner. Dependency relates not only to financial viability, but also to the other essential types of support on which an organization may depend to continue existing and fulfilling its mission.
3. The last dimension addresses the conditions in the community and the social ecological systems in which the project evolves:
   • Its first component refers to community capacity and the overlapping elements of cultural acceptance and social cohesion. All these elements can be viewed under the umbrella concept of community competence.
   • The second component includes a number of elements within the environment of the project in the largest sense: national policies, the economic and political environment, and the environmental and human development situation. These elements are frequently, but not always, outside a project’s scope of intervention. They may, however, be relevant to a sustainability assessment within a CS project, as they indicate important transitional stages of development, which PVOs/NGOs cannot ignore

The framework suggests many elements within these components, based on best practices and PVO experiences. These elements would be used in menu-driven applications of the OAD, but were not presented during the Dialogue Day. More discussion of the content of the framework is available in “The Child Survival Sustainability Assessment (CSSA): For a shared sustainability evaluation methodology in Child Survival interventions” http://www.childsurvival.com/documents/CSTS/sustainability.cfm

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